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Monday, October 29, 2018

Vote like your health care coverage depends on it,

because it does.

Cheryl and I already voted, by mail. 2018 mid-term election day is November 6th. Continuing GOP control of Congress bodes severely ill for U.S. health care policy. Senate Majority leader Mitch McConnell has made no secret of his intent to come after "the Big Three: Social Security, Medicare, and Medicaid." Of those, the first two have historically been non means-tested entitlements available to all who have paid sufficiently into the system across their working lives, irrespective of assets or net worth at retirement. Many on the GOP side long to turn them into penurious liquidate-all-your-assets-first "welfare" programs (e.g., Medicaid).

"We have to come up, and we can come up with many different plans. In fact, plans you don't even know about will be devised because we're going to come up with plans, -- health care plans -- that will be so good. And so much less expensive both for the country and for the people. And so much better.” - Candidate Donald Trump, September 14th, 2016 on the Dr. Oz show.
"You're going to have such great health care, at a tiny fraction of the cost, and it's going to be so easy." - Candidate Donald Trump, Oct 2016 Florida campaign rally.
"Who knew health care could be so complicated?" - President Donald Trump, 2017.
 No, I don't like the guy. Wonder why?

Some prior KHIT posts on the policy topics:

The Presidential Oaf of Office

What will the 45th President do about health care?

"Overcharged?" Paying for health care

An American Sickness
Population Health and an aging world
The U.S. healthcare "system" in one word: "shards"
ObamaCare is a great mess

Rationing by "Price"

For now. Below, a couple from another blog of mine, nearly a decade ago.

The U.S. health care policy morass

Public Optional

Then there's my 1994 grad school Argument Analysis paper addressing the "Single Payer" proposal published in JAMA [pdf].

Been thinking about this stuff for a long time. I first came to the health care space in 1993 with my first of three QIO stints [pdf]. Again, while the founding core topic of this blog is that of Health IT, I range far and wide as I see fit. As to policy, the finest InfoTech and clinical science we can muster will remain inadequate if health care services are to be predominantly privileges of affluence.


All the ways Republicans are trying to destroy pre-existing conditions coverage

Do you have a pre-existing condition, like arthritis, diabetes, asthma, or about a million other problems? About one in four Americans (or over 50 million people) do. Even if you aren't personally in that group, it's highly likely one of your friends or family are — and what's more, such a condition can develop at any time.

That's why it's important for each and every American to know that, contrary to what President Trump claims, the Republican Party has made great efforts to snatch health insurance from people with pre-existing conditions. They have tried multiple times to do it through legislation and are trying to do it right now through legal and regulatory efforts…
All of the pols are publicly swearing ad nauseum on the stump and in the media that they will "protect those with pre-existing conditions." Just about all of the Republicans are lying.


All of us, but in particular our politicians, are often sloppy with the use of words. "Universal coverage," "universal access," and "universal health care" are not synonymous. You may buy a "junk" policy to comply with the ACA "coverage" requirement, but actual claims payment for health care services and products may be extremely limited. Tangentially, all us may have unfettered "access" to stroll into any Mazerati dealership in the nation. Whether we can afford to buy any of the vehicles offered is entirely another matter. Beware of political Weasel Talk.

My wife and I are now Medicare benes. We have qualified "universal coverage" and "access" to all clinicians and facilities that accept Medicare payment (i.e., most ambulatory and inpatient providers). As those following this blog know, I've had high utilization this year culminating in hernial surgery and then the Big Show -- my open heart aortic valve replacement "SAVR" operation (happy to report I'm doing fine, and am in my 3rd week of cardiac rehab PT. My cardiologist says it's realistic that I could get all the way back to my absurd full-court hoops obsession).
I should note that, despite my coverage being an "entitlement" (earned via a working lifetime of paying into the system through Medicare taxes), it is by no means "free" (a.k.a., comprehensive "first-dollar coverage"). Between my Medicare Part-B premiums, SureScripts Rx policy, and my high-deductible "Part-F" Humana "Medicap" policy, I pay about $2,400 a year in premiums, plus deductible and co-pay "OoP" expenses. Similarly does my wife. Year-to-date, we're OoP (out-of-pocket) about $7k total (not counting what we spent caring for our late daughter). My latest total year-to-date "chargemaster" (ludicrous accounting fiction) "billed charges" are about $538k, as shown on my current Humana EoB statement. I have no way to know who got how much of the actually reimbursed (and much smaller) percentage of that. 
In short, it behooves us all to critically evaluate health care reform policy proposals, and vote accordingly. It won't be easy. I'm no Pollyanna with respect to this vexing topic.

None of this is exactly news. In addition to the many post links I've cited above, read Elhauge's 1994 "Allocating Health Care Morally" [pdf] to wit:
"Health law policy suffers from an identifiable pathology. The pathology is not that it employs four different paradigms for how decisions to allocate resources should be made: the market paradigm, the professional paradigm, the moral paradigm, and the political paradigm. The pathology is that, rather than coordinate these decisionmaking paradigms, health law policy employs them inconsistently, such that the combination operates at cross-purposes..."
Not a lot has changed for the better in the ensuing 24 years.


From The Atlantic:
Judges Shouldn’t Have the Power to Halt Laws Nationwide
A court in Texas may put Obamacare on ice—everywhere.

Democrats were ecstatic when a judge in Honolulu barred enforcement of the Trump administration’s travel ban. They were thrilled when a judge in Chicago halted a policy to rescind grant funding to sanctuary cities. In both cases, the judges extended their ruling beyond the litigants to the whole country, issuing so-called national injunctions.

For opponents of Donald Trump’s administration, this legal maneuver has seemed like a godsend. Now it may come back to haunt them, as a single federal judge in Texas considers putting the Affordable Care Act on ice—not only in Texas, but anywhere in the country.

Can one judge really impose his ruling from one coast to the other?

A group of Republican state attorneys general certainly think so. In their view, Congress knocked the constitutional legs out from under Obamacare when it repealed the penalty for going without insurance. They’ve sued to stop the federal government from implementing any part of the law—including its protections for preexisting conditions and the Medicaid expansion—across all 50 states…
No end of stuff to stay on top of. My only pushback thought regarding the foregoing "national injunction" concern is that the ACA ("Obamacare") is not some new, controversial executive order policy, it's a now long-standing law that has withstood SCOTUS challenge.

I guess we'll soon see.

JONATHAN KARL: One of the central issues is health care. You’ve been saying Democrats want to take away preexisting conditions. I mean, it’s your administration that’s supporting a lawsuit that would allow health insurance companies –-

DONALD TRUMP: No, but I want to replace preexisting conditions and I’ve always been there. What the Democrats are going to do is destroy our entire health care and you’re not going to have any health care. You would destroy the country. You are not going to have health care. The Democrats are going to literally –- you’ll have to pay three times the taxes and they’ll destroy health care as we know it in this country. You won’t have preexisting conditions. You won't have anything.
Okeee-dokeee, then. Seriously? Yeah, he has "the best words."

What’s at Stake for Science in the Midterms
Scientists-turned-politicians are hitting the campaign trail and appealing for votes based on truth and reason

Bryson Masse
In early October, a United Nations report [KHIT link] warned that humanity has just 12 years to mitigate climate change and save the planet. When, a few days later, “60 Minutes” reporter Lesley Stahl asked President Trump about his position on climate change and the scientists who describe the situation as “worse than ever,” he replied, “You’d have to show me the scientists, because they have a very big political agenda, Lesley.”

Do they ever.

Since 2017, the White House and a Republican-controlled legislative wing have taken shears to environmental protections, reduced the size of national parks, and attempted to militarize space. Such changes have inspired a new generation of STEM (science, technology, engineering, and math) professionals to run for office, and they’re gunning for the midterms.

“There are more talk radio show hosts in Congress than there are chemists or physicists,” said Shaughnessy Naughton, president of 314 Action. “I think part of what running as a scientist brings is an outsider status, but one that actually has credibility in a lot of issues that are important to Americans.”

314 Action describes itself as the pro-science resistance, and it is focused on “aggressively advocating for a pro-science agenda in Washington, D.C., and in local and state legislatures,” according to its website. It’s named for the first three numbers of pi. Since the group put out a call in January 2017 for scientists to run for office, 314 Action has heard from 7,000 scientists seeking help for their campaigns. The group has trained 1,400 of them, and also funds campaigns and puts together financial and communications strategies for inexperienced candidates.

Whether it’s health care, cybersecurity, nuclear weapons policy, or just evidence-based facts, Naughton thinks scientists are equipped to turn D.C. around…
 Indeed. Read the entire article. Excellent. Science! (Notwithstanding that "I am not a scientist.")

Science. Your health depends on it.


From THCB:
We Know We Have to Address the Social Determinants of Health. Now What?
by Rebecca Fogg

In the run-up up to this month’s mid-term elections, health care appears to be just one of many burning political issues that will be influencing Americans’ votes. But delve into nearly any issue—the economy, the environment, immigration, civil rights, gun control—and you’ll find circumstances and events influencing human health, often resulting in profound physical, emotional and financial distress.

Evidence suggests that separating immigrant children from their families could cause lasting emotional trauma. Gun violence and adverse weather events destroy lives and property, and create hazardous living conditions. Structural racism has been linked to health inequities, for instance where housing discrimination leads to segregation of black buyers and renters in neighborhoods with poor living conditions. The list goes on, and through every such experience, affected individuals, their loved ones, and their communities learn implicitly what health care providers have long known: that health status depends on much more than access to, or quality of, health care.

Some of the most influential factors are called social determinants of health, and they include education, immigration status, access to safe drinking water, and others. Society and industry must collaborate to address them if we are to reduce the extraordinary human and economic costs of poor health in our nation…
I've posted on "social determinants" impacts many times. And, we now have to add "exposomics" to the list (epigenetic injury owing to persistent toxic "upstream" factors).

See the work of The Christensen Institute in this regard.

"The Clayton Christensen Institute is a nonprofit, nonpartisan think tank dedicated to improving the world through disruptive innovation. Founded on the theories of Harvard professor Clayton Christensen, the Institute offers a unique framework for understanding many of society’s most pressing issues around education, healthcare, and economic prosperity.
Our mission is ambitious but clear: work to shape and elevate the conversation surrounding these issues through rigorous research and public outreach. The Institute is redefining the way policymakers, community leaders, and innovators address the problems of our day by distilling and promoting the transformational power of disruptive innovation."
I was not aware of this outfit 'til today. My Bad. Have to study up on their work. Ahhh..."disruptive innovation."

CI's health care topics.

Vote as if the future of of your health care depends upon it. Because it does.

Once the mid-terms hubbub is over, I'll be reporting on a new book I just downloaded.

I got an Amazon email recommendation. I bit. We shall see. A young man on the move. Recall my prior post "Data Science?" Will have to triangulate with other relevant texts.


President Trump during his MAGA Rally in Chattanooga on Sunday Nov 4th:
“They [the Democrats] want to take away your health care [and] they want to impose socialism on our country;”

“If Democrats gain power on Tuesday, they will try to raid your Medicare to fund socialism, you know that.”

“The Democrat health care plan would obliterate Medicare and eliminate Medicare Advantage for more than half a million Tennessee seniors.

“The Democrats’ plan to destroy health care also includes giving away your benefits to illegal immigrants, you know that.”

“As we speak, Democrats are openly encouraging millions of illegal aliens to break our laws, violate our borders, and destroy our nation in so many ways, and they want to sign them up for free welfare, free health care, free education and, most importantly, the right to vote. They want them to vote. Come on in and vote. They love them voting.”

“And Republicans will always protect patients with pre-existing conditions. Please remember that.”
Right. BTW, from the source Atlantic article:
None of those claims is hard to debunk—but the last one, about Republicans always protecting pre-existing conditions, speaks to a president and many other Republicans running for Congress who have simply become unmoored from the truth on health care, which polling shows is by far the number one issue among voters.

Twenty Republicans-led states are awaiting a federal court ruling on a lawsuit aimed at demolishing the vestiges of the Affordable Care Act that remain in existence, including the hugely popular provision that prohibits insurance companies from denying insurance to people with serious medical problems or “pre-existing conditions.” The Trump administration has filed a brief in support of the lawsuit. And just the other week, the administration issued a rule that makes it easier for states to begin offering watered down insurance plans that do not include pre-existing conditions, which some have begun doing.

But none of this has stopped Republican candidates for Congress in those 20 states, or the president himself, from claiming that Republicans will always protect the very thing they are now in court to abolish...

More to come...

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